MEDICARE: KEREN RAY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	34-007950	OH
2	208M00000X	Hospitalist Physician	34.007950	OH
3	207R00000X	Internal Medicine Physician	02008952A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417978263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEREN RAY DO

Provider Business Mailing Address
First Line	:	1149 EXPERIMENT FARM RD
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1071
Country	:	US
Telephone Number	:	937-914-7179
Fax Number	:	937-522-9960

Provider Business Practice Location Address
First Line	:	3512 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4631
Country	:	US
Telephone Number	:	260-483-9081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	05/11/2026

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